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Basal Requirements Have Shot Up In The Last 2 Weeks And I Don't Know Why

Sideburnt

Well-Known Member
Messages
124
Type of diabetes
Type 1
Treatment type
Insulin
Hi all, really looking for some advise or comparable experiences.

I've been a T1 for 6 1/2 years now and have seen my basal creep up from 8 to 18 units of Humulin I over that time period and hardly shift from 18 units for the last 3 years.

In the last 2 weeks my bolus requirements have shot up and with trial and error I've found that I now need 40 units to keep my numbers in control which is really confusing me almost like my insulin resistance has changed but hasn't effected my bolus requirements.

A few things that have changed in the last 6 months;

I've been using Fiasp Ultra rapid insulin.
I've twice taken Fuconazole to clear a stubborn yeast issue.

No weight gain, I exercise, diet hasn't changed, I've tried changing to different vials from different batches. I'm worried that with such a dramatic increase that a temporary environmental change my flip and leave me with double the background I need and send me into a brutal hypo. I guess it's possible that an extended honeymoon has ended but so dramatically? and without changing my bolus ratio?
 
Hmm, you can try ringing your clinic for advice but in the absence of that I'd suggest going to your GP and getting checked out, maybe a full set of blood tests, just to check you haven't got some kind of illness.

If you're using an insulin pen are you sure that it it's working correctly?

That's my two ideas. Hopefully someone else will come up with something better. Good luck.
 
Thanks for your reply, first thing I did was change both my pen and vial (top a different batch). I thought I must have left it in the sun or something similar.

Sadly not the solution I hoped for.
 
OK, really clutching at straws here, but do you overuse your basal injection sites (am guessing you inject bolus in same places so if it were an issue for basal it woulod be for bolus as well, but it's still worth asking.)?
 
Possibly, and I don't know anything much about this, having only recently starting thinking about this myself, but Fluconazole, as an antifungal medicine, could have impacted your gut bacteria, which could possibly increase insulin resistance, and be driving the need for extra insulin.

It might be worth trying to improve it, with some food containing probiotics, and prebiotics. It's a complicated issue so I don't know where you should start, but there is quite a lot of stuff on the internet about it, most of it gives the similar advice, though some is borderline cranky, so you need to sift a little.
 
I've switched to a different buttock (mine obviously) and take a daily probiotic anyway.

It might just be bad timing with the Fluconazole but it did wreck me, hard to describe but I felt sick and ill with it for a couple of days.

As a test last night I did a double exercise bike session for 1h30. Which would normally leave me needing to dial back my basal by 30% and it made absolutely no difference whatsoever. Very very unusual for me.

Other things I've noticed in the last 6 months. Fiasp stopped absorbing 'ultra rapidly'. It takes about as long, it not slightly quicker than Apidra and does not give me the rapid absorption I noted when I first started to use it, also carbs seem to spike way more than they should twice as much in most cases. I can be at 5mmol and spike up to 12 with only 30g of carbs, which would have normally only taken me to 8 if I'd forgotten to bolus. It all feels connected but I'm stumped.

I've rung my diabetes clinic today to talk about it but honestly I don't know what they'll say. I think I'll get a general bloodwork done too, that was some good advice.
 
Sideburnt said:
Humulin
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Why Humulin? Why not switch to a modern basal like Levemir, Lantus or Tresiba? Humulin is not really a basal insulin at all, it's an intermediate-acting insulin that was part of the standard treatment until basal analogues came along. If it works for you, great, but I would consider switching to a modern regimen if it isn't.
 
Because I don't need much if any basal during the day. Humalin I is an 18h insulin with little to no activity after 12h however the peak at 2-6h is perfect to offset my overnight rise and go some way to counteract dawn phenomenon.
 
Sideburnt said:
Because I don't need much if any basal during the day. Humalin I is an 18h insulin with little to no activity after 12h however the peak at 2-6h is perfect to offset my overnight rise and go some way to counteract dawn phenomenon.
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That makes sense, but because Humulin I is a suspension, many people have problems with it working consistently from day to day. Have you tried Levemir? It also lasts about 12 hours on smaller doses, and you can take more at night and less during the day by taking it every 12 hours. It has a slight peak as well, and I find it works to counteract the dawn phenomenon if I take more at night and at 9 or 10pm so it peaks around 3-4am when I need it to. It is very consistent from day to day as well. Ive used Fiasp and have had problems with it. I don't find it consistent for whatever reason and don't find it that much faster than NovoRapid on MDI. It's definitely faster in a pump, but causes other problems (such as sites not lasting as long).
 
Hi Sideburnt

You said you're taking fuconazole for a stubborn infection. It's possibly the infection that's causing an increase in your bloods causing the need for more insulin.

I've just taken this medication and my bloods were slightly higher before hand then I noticed it creeped up even more when I took the antibiotic.

Hopefully once the infection has cleared up your insulin levels will be back to normal.

Ermintrude
 
Any med will get processed by the liver. It could be your liver needs a detox now that med is finished. A good anti-oxident for 3mths? R-ala supplement is most diabetics choice as good for nerve repair too.
Ps. Less stressful exercise too. Stressful work/exercise brings out cortisol which increases bgs.
 
Hi @Sideburnt,
Possibilities:
1) I find the longer being diabetic the less tolerance to changes and insulin requirement may tend to go up from the end of the honeymoon phase and maybe is one of the reasons for the change in Humulin doses you have noticed but see 2) etc below.
2) Fluconazole is known to cause liver inflammation = up insulin resistance
3) yeast infection might allow a second infection like a low grade bacterial one to happen, ( noted in possible side-effects) more inflammation = up insulin resistance
4) disturbance of bowel bugs due to Fluconazole --> up insulin resistance
5) The Fiasp by day may not be covering your insulin requirements , between when Humulin is not active and when Humulin is next injected. Insulin resistance and lack of basal insulin at the moment by day might have something to do with Fiasp's poorer effect
6) it may be that once insulin resistance is lowered any Dawn effect may be less
7) if 6) is true, then a more reliably absorbed long acting insulin taken say twice daily will give you 24 hour basal insulin cover and may improvement overall control over the daytime.
8) you are probably aware that if you exercise with BSL > 14 mmol/l the BSL goes up and is less likely to fall later
9) maybe there is some additional, as yet undiagnosed reason for your yeast infection's tenacity which is having an effect on your body and insulin requirements.
I hope that the above helps.
 

I think you nailed it with this being a secondary infection or period of inflammation. Something changed last night, yesterday 40 units kept me even overnight and then out of nowhere last night for the first time in 3 weeks my dose appears to have reduced significantly and 40 units crashed down to a lovely 1.5mmol/l at 2am and kept me low for a few hours. This situation was what I was afraid of, there's part of me that would have preferred my new basal staying at 40 units. No idea what to do tonight, probably reduce by 10 units and see what happens, at least that does wont allow me to visit either end of the BG spectrum too extremely.

This is all pretty dangerous, I've no idea what would have happened if I hadn't set my Libre up through Xdrip to alarm. Drop even lower I guess. Grimm, not worth dwelling on.
 
Hi @Sideburnt, I am glad you survived OK !!!
And I hope whatever changed is going to allow things to improve further.
And because of the peak period of Humulin's action , 2 am would fit in.
Hopefully the Dawn effect is gong to improve too.
Best Wishes and fingers crossed !!
 
Sideburnt said:
No idea what to do tonight, probably reduce by 10 units and see what happens, at least that does wont allow me to visit either end of the BG spectrum too extremely.
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Just bear in mind that your liver may not yet have recovered from this morning's hypo extravaganza so I'd definitely underdo rather than overdo the insulin. Much easier to do a correction dose rather than have a midnight hypo.

Good luck.
 
EllieM said:
Just bear in mind that your liver may not yet have recovered from this morning's hypo extravaganza so I'd definitely underdo rather than overdo the insulin. Much easier to do a correction dose rather than have a midnight hypo.

Good luck.
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Good advise. I'll switch back to my old overnight dose and see how I get on.

I'm goosed today, so tired from last night. What a ride.
 
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